Mediators between Theoretical and Practical Medieval Knowledge: Medical Notebooks from the Cairo Genizah and their Significance

Abstract

This article presents a plethora of fragments from the medical notebooks found in the Cairo Genizah that comprise a unique source of historical data for scholarly study and for a better understanding of the ways in which medieval medical knowledge in Egypt was transferred from theory to practice and vice versa. These documents provide the most direct evidence we have for preferred practical medical recipes because they record the choices of medical practitioners in medieval Cairo. Since the language most commonly used in them was Judaeo-Arabic, they were evidently written by Jews. The medical genre in the notebooks was primarily pharmacopoeic, consisting of apparently original recipes for the treatment of various diseases. There are also a few notebooks on materia medica. The subject matter of the Genizah medical notebooks shows that they were mostly of an eclectic nature, i.e. the writers had probably learnt about these treatments and recipes from their teachers, applied them at the hospitals where they worked or copied them from the books they read. Foremost among the subjects dealt with were eye diseases, followed by skin diseases, coughs and colds, dentistry and oral hygiene, and gynaecological conditions. The writers of the Genizah notebooks apparently recorded the practical medical knowledge they wished to preserve for their future use as amateur physicians, students, traditional healers or professional practitioners.

Full text

Med. Hist. (2013), vol. 57(4), pp. 487–515. c
The Author 2013. Published byCambr idge University Press 2013
doi:10.1017/mdh.2013.56
Mediators between Theoretical and Practical Medieval
Knowledge: Medical Notebooks from the Cairo
Genizah and their Significance
EFRAIM LEV∗
Department of Eretz Israel Studies, University of Haifa, Haifa, 31905, Israel
Abstract: This article presents a plethora of fragments from the
medical notebooks found in the Cairo Genizah that comprise a
unique source of historical data for scholarly study and for a better
understanding of the ways in which medieval medical knowledge in
Egypt was transferred from theory to practice and vice versa. These
documents provide the most direct evidence we have for preferred
practical medical recipes because they record the choices of medical
practitioners in medieval Cairo. Since the language most commonly
used in them was Judaeo-Arabic, they were evidently written by Jews.
The medical genre in the notebooks was primarily pharmacopoeic,
consisting of apparently original recipes for the treatment of various
diseases. There are also a few notebooks on materia medica. The
subject matter of the Genizah medical notebooks shows that they
were mostly of an eclectic nature, i.e. the writers had probably learnt
about these treatments and recipes from their teachers, applied them
at the hospitals where they worked or copied them from the books
they read. Foremost among the subjects dealt with were eye diseases,
followed by skin diseases, coughs and colds, dentistry and oral hygiene,
and gynaecological conditions. The writers of the Genizah notebooks
apparently recorded the practical medical knowledge they wished to
preserve for their future use as amateur physicians, students, traditional
healers or professional practitioners.
Keywords: Cairo Genizah, History of Medicine, Jewish, Medieval
Middle East, Middle Ages, Notebook
∗Email address for correspondence: elev@univ.haifa.ac.il
This article is dedicated to the late Mrs Shulie Reif, noble woman, talented editor, true friend and a wonderful
hostess to many Genizah scholars in Cambridge for more than thirty years. I first met Shulie in Cambridge
a decade ago when I started to learn about the medical issues in the Genizah. My research could not have
been conducted without the devoted work of Sara Kemp who grew up in the Jewish community of Cairo and
helped to transcribe the Genizah fragments. I express my deepest thanks to Stefan Reif, former head of the
Taylor–Schechter Genizah Research unit, who helped me enter the world of Genizah research, and to Francis
B. Brevart of the University of Pennsylvania, Monica Green of the Arizona State University, Peter Jones,
Kings College, Cambridge; Avi Shivtiel, Leeds; Leigh Chipman of the Hebrew University in Jerusalem, Zohar
Amar of Bar Ilan University in Israel, and Yaron Serri of Zefet Academic College in Israel, and especially the
anonymous reviewers for their helpful remarks. Special thanks go to my colleagues at the Taylor–Schechter
Genizah Research Unit at Cambridge University Library, who shared with me their enormous knowledge and
experience and supported me with helpful comments: especially Ben Outhwaite (director of the Unit), the late
Friedrich Niessen, Amir Ashur, Gabriele Ferrario, Esther-Miriam Wagner and Sara Sykes. I thank the Syndics
of Cambridge University Library for permission to publish the Genizah fragments.

488 Efraim Lev
Despite the loss of knowledge due to the extinction of ancient and medieval manuscripts,1
it is fortunate that our knowledge of medieval Arab medicine and pharmacology2can
be enhanced by a large repository of medical literature of that period found among
the Cairo Genizah manuscripts, which cover a wide variety of subjects. These subjects
include medical doctrines and theories, preventive medicine, the treatment of diseases and
ailments, pharmacopoeias listing remedies and how to prepare them, materia medica and
their different names, qualities and medical uses. Most of these medical compendia were
written by learned physicians and pharmacists and intended both as teaching material and
for reference purposes in the practical treatment and healing of patients.
The relationship between theory and practice in medieval medicine is an important topic
for research and discussion. Even though most studies on the subject have dealt mainly
with medieval European medicine, the potential value of the Cairo Genizah as a pertinent
source for such discussion was noted.3
As a result of focused study over many years of the wealth of medical related
manuscripts in the Cairo Genizah and the struggle to learn and distinguish between
practical and theoretical texts, a new genre has now emerged that blurs the borderlines
between them. Dozens of fragmented medical documents without strict theoretical
characteristics or clear-cut practical ones were written by and served Jewish practitioners
in medieval Cairo, mainly between the eleventh and thirteenth centuries. This was most
probably the way these practitioners organised and recorded their preferred recipes in
notebook form. I would therefore like to claim that this intermediary genre of medical
notebooks lies precisely on the borderline between theora and practica,4or theory and
practice,5and represent one of the ways, or alternatively one of the tools, by which
theoretical medical knowledge became practical know-how and vice versa.
1John Cisne L., ‘How Science Survived: Medieval Manuscript “Demography” and Classic Texts Extinction’,
Science, 307 (2005), 1305–7.
2Manfred Ullmann, Islamic Medicine (Edinburgh: Edinburgh University Press, 1978); Peter E. Pormann and
Emilie Savage-Smith, Medieval Islamic Medicine (Cairo: The American University of Cairo Press, 2007);
Savage-Smith Emilie, ‘Medicine’, in Roshdi Rashed (ed.), Encyclopedia of the History of Arabic Science
(London/New-York: Routledge, 1996), 3:903–62; Emilie Savage-Smith, ‘T
.ibb’, The Encyclopaedia of Islam,
2nd edn (Leiden: Brill, 1999), 10, 456; Carl Brockelmann, Geschichte der Arabischen Litteratur (Leiden:
Brill, 1898–1949), I, 230–40, 482–94, II, 170–2, 219, 242, 276–7, 333–5, 477–80, 545, 594–5, 617, I (suppl.)
412–26, 884–901, II, (suppl.) 168–70, 218–9, 252, 298–9, 326–7, 366–7, 491–3, 592–3, 625–7, 666–7, 713–4,
1027–32; Fuat Sezgin, Geschichte des Arabischen Schrifttums (Leiden: Brill, 1970), III, 3–340; Sami Hamarneh,
‘The Rise of Professional Pharmacy in Islam’, Medical History, 6 (1962), 59–63; Sami Hamarneh, ‘Sources
and Development of Arabic Medical Therapy and Pharmacology’, Sudhoffs Archive, 54 (1970), 30–48; Sami
Hamarneh, Origins of Pharmacy and Therapy in the Near East (Tokyo, 1973); Max Meyerhof, ‘The Background
and Origins of Arabian Pharmacology’, Ciba Symposia, 6 (1973), 1847–56; Martin Levey, Early Arabic
Pharmacology: An Introduction based on Ancient and Medieval Sources (Leiden: Brill, 1973); M. Ali and
J.S. Qadry, ‘Contribution of Arabs to Pharmacy’, Studies in History of Medicine, 6 (1982), 43–53; Michael
Rogers, ‘The Arab Contribution to Botany and Pharmacology’, Arab Affairs, 6 (1988), 71–81; Oliver Kahl, The
Dispensatory of Ibn at-Tilm¯
ıd: Arabic Text, English Translation, Study and Glossaries (Leiden/Boston: Brill,
2007); Leigh Chipman, World of Pharmacy and Pharmacists in Maml¯
uk Cairo (Leiden: Brill, 2009).
3John M. Riddle, ‘Theory and Practice in Medieval Medicine’, Viator, 5 (1974), 157–84.
4Luke Demaitre, ‘Theory and Practice in Medical Education at the University of Montpellier in the Thirteenth
and Fourteenth Centuries’, Journal of the History of Medicine, 30 (1975), 103–23.
5Danielle Jacquart, ‘Theory, Everyday Practice, and Three Fifteenth-Century Physicians’, Osiris, 6 (1990),
140–60; Andrew Cunningham, ‘The theory/practice of medicine: division of medicine: two late Alexandrian
legacies,’ in Teizo Ogewa (ed.), History of Traditional Medicine (Tokyo: the Taniguchi Foundation, 1986),
303–24; Jole Agrimi and Chiara Crisciani, Edocere medicos; Medicina scolastica nei secoli XIII–XV (Naples:
Guerini e associati, 1988), 21–47.

Mediators between Theoretical and Practical Medieval Knowledge 489
A study of Graeco-Roman case-histories in medical literature reveals that during the
process of assimilation of classical and Hellenistic medicine into the medieval Islamic
medical tradition, it was not only the theoretical principles that were adopted but also
the literary models for presenting medical knowledge, including the case-history model.
According to Alvarez-Millan who compared the case histories of Rufus of Ephesus and
Galen with those by the tenth century Islamic physician al-R¯
az¯
ı [Rhazes] (Kit¯
ab al-
Taj¯
arib), the clinical records of the latter constituted an instrument with which to study and
expand medical knowledge as well as to provide useful material for the medical training of
students.6Alvarez-Millan also studied the description of diseases occurring in the al-R¯
az¯
ı
casebook: the largest and oldest collection of case histories known in medieval Islamic
medical literature. By comparative analysis, she showed that the medical knowledge and
the therapeutic advice so meticulously described in theoretical works were not comparable
to the physician’s medical performance. On the contrary, it appears that learned treatises
served purposes other than that of determining medical practice.7
Medicine and disease in medieval Islam have thus far been approached through
theoretical medical treatises, with the assumption that learned medical texts are a
transparent reflection of the actual practice of medicine. The extent to which the ideas and
theoretical principles in those treatises were actually carried out in practice has yet to be
explored adequately. Other research, which dealt with and analysed 260 Greek medical
papyri of a theoretical and practical nature found in Egypt (third century BC–seventh
century CE), showed that these Greek recipes were not solely based on the classical
medical tradition but also on local Egyptian pharmacopoeias.8
Medical Documents in the Cairo Genizah
For hundreds of years, especially during the rule of the F¯
at
.imids, Ayy¯
ubids and Maml¯
uks
over Egypt, the Jewish community in the country, mainly in Cairo and Alexandria, existed
as one of the most important centres of Jewry in the world. The community maintained
extensive internal and international ties and engaged in widespread social, economic
and religious activity. The Jews of Fust
.¯
at
.(Old Cairo) worshipped in a few synagogues,
one of which was named the ‘Ben Ezra’ synagogue that served as the centre of the
‘Palestinian’ Jewish community. This community had used the same building as their
religious centre for almost a millennium, and during that time assigned one of the upper
rooms as a ‘Genizah’, or repository for discarded handwritten material. As prescribed
by Jewish religious custom observed in all Jewish communities around the world since
early times, sacred books no longer in use were to be either deposited in a Genizah or
buried. The community in Fust
.¯
at
.made use mainly of the first option, and expanded it in
such a way that almost every piece of writing, whether secular or religious, which passed
through the hands of its members was consigned to the Genizah. Fortunately enough,
6Cristina Alvarez-Millan, ‘Graeco-Roman Case Histories and their Influence on Medieval Islamic Clinical
Accounts’, Social History of Medicine, 12 (1999), 19–43.
7Cristina Alvarez-Millan, ‘Practice versus Theory: Tenth-century Case Histories from the Islamic Middle East’,
Social History of Medicine, 13 (2000), 293–306.
8Isabella Andorlini, ‘Prescription and practice in Greek medical papyri from Egypt’, in Harald Froschauer and
Cornelia R¨
omer (eds), Zwischen Magie und Wissenschaft: ¨
Arzte und Heilkunst in den Papyri aus ¨
Agypte (Wien:
Phoibos, 2009), 23–33.

490 Efraim Lev
due to the dry climate of Egypt, vast quantities of these manuscripts were preserved.9
During the nineteenth century the fragments slowly found their way into the hands of
private collectors, and soon different academic institutes and libraries were assembling
their own collections.10 The Genizah documents touch on almost all social, cultural and
economic aspects of life, including medicine, in medieval Mediterranean communities.
The importance of their discovery was further highlighted by the fact that Jews constituted
one of Egypt’s significant minorities. The community not only mirrored Mediterranean
society as a whole but was also famed for its medical heritage and its learned physicians.11
The potential of the Genizah collection for the study of medical issues has already
been noted by several scholars.12 However, little in-depth research seems to have been
conducted to explore actual medieval medical practices. The approximately 1800 medical
documents extracted so far in the Taylor–Schechter (T–S) Genizah Collection in the
Cambridge University Library,13 comprising ‘in situ fossils of medical knowledge’,14
provide a direct insight into medieval medical theory and practice, mainly from the
eleventh to the thirteenth century, and reveal a unique potential for resurrecting lost
knowledge.15
In 2003 a new interdisciplinary project was launched in Cambridge dealing with medical
issues in the lives of the people portrayed in the Genizah manuscripts. A team of scholars
from various fields, including historians, medical historians, linguists and biologists, are
now at work identifying, categorising, studying, editing and publishing papers on the
numerous fragments concerned with medicine in the Genizah collections. As a founder of
that team, I have studied three Genizah collections in the UK for my research on medieval
9Stefan C. Reif, A Jewish Archive from Old Cairo: The History of Cambridge University’s Genizah Collection
(Richmond: Curzon Press, 2000), 1–22.
10 Binyamin Richler, Guide to Hebrew Manuscript Collections (Jerusalem: Israel Academy of Sciences and
Humanities, 1994).
11 Shelomo Dov Goitein, A Mediterranean Society (Berkeley: University of California Press, 1967–88), I, 153–4;
209–24; II, 240–72.
12 Albert Dietrich, Zum Drogenhandel Im Islamischen Agypten (Heidelberg: Carl Winter, 1954); Shelomo Dov
Goitein, ‘The Medical Profession in the Light of the Cairo Genizah Documents’, Hebrew Union College Annual,
34 (1963), 177–94; Fenton Paul, ‘The Importance of the Cairo Genizah for the History of Medicine’, Medical
History, 24 (1980), 347–48; Estee Dvorjetski, ‘The contribution of the Geniza to the study of the medicinal
hot springs in Eretz-Israel’, in Proceedings of the Twelfth World Congress of Jewish Studies (Jerusalem: World
Union of Jewish Studies, 1990), II, 85–93; Mark R. Cohen, ‘The Burdensome Life of a Jewish Physician and
Communal Leader: A Geniza Fragment from the Alliance Israelite Universelle Collection’, Jerusalem Studies in
Arabic and Islam, 16 (1993), 125–36; Colin Baker, ‘Islamic and Jewish Medicine in the Medieval Mediterranean
World: The Genizah Evidence’, Journal of the Royal Society of Medicine, 89 (1996), 577–80; Haskell D. Isaacs,
‘A Medieval Arab Medical Certificate’, Medical History, 35 (1991), 250–7.
13 Haskell D. Isaacs, (with the assistance of Baker Colin F.), Medical and Para-Medical Manuscripts in the
Cambridge Genizah Collections (Cambridge: Cambridge University Press, 1994); Friedrich Niessen and Efraim
Lev, ‘Addenda to Isaacs Catalogue, ‘Medical and Para-medical Manuscript in the Cambridge Genizah Collection
Together with the Edition of Two Medical Documents T–S 12.33 and T–S NS 297.56’, Hebrew Union College
Annual, 77 (2008), 131–65.
14 Sharon Larimer Gilman and Florence Eliza Glaze, ‘How Science Survived: Medieval Manuscripts as Fossils’,
Science, 307 (2005), 1208–9.
15 Efraim Lev and Zohar Amar, ‘Fossils’ of Practical Medical Knowledge from Medieval Cairo’, Journal of
Ethnopharmacology, 119 (2008), 24–40.

Mediators between Theoretical and Practical Medieval Knowledge 491
medicine in Egypt and the Mediterranean region: the T–S Genizah Collection;16 the John
Rylands Cairo Genizah collection;17 and the Mosseri collection.18
A few genres of medical fragments were defined such as books,19 prescriptions,20 lists
of drugs and correspondence.21 This article will focus on medical notebooks that form an
intermediate genre between books and prescriptions since they do not easily fit into any of
the fragment categories described above. Most of the notebooks, which consist of a few
dozen fragments identified in the Cairo Genizah, create the opportunity to study another
aspect of medieval medicine.
Through my study and analysis of the medical fragments from the Cairo Genizah,
a methodology was gradually devised for distinguishing between the various kinds of
information derived from them and for differentiating between theoretical and practical
medical knowledge.22
A. Theoretical knowledge of medicine is purported to be mainly contained in
general medical books which provide information regarding the basics in medicine
and pharmacology. ‘Theoretical medical knowledge’ can be defined as information and
medical expertise transmitted in writing by experienced scholars, mainly in medicine and
pharmacology, whose main objective was that of teaching and directing medical students
and of safeguarding the medical knowledge that had been accumulated, developed or
practised by them for future reference. Jones, in his research on medieval English medical
books, says that: ‘Academic medical books are admirably suited to teaching and learning,
but not to the problems faced by our medical practitioner when treating patients.’23
To date, about 1360 fragments of medical books have been identified in the T–S
collections and dozens in each of the other collections mentioned above. These books
were copied or translated from works written by classical or medieval physicians and
pharmacologists. Most of the books are written in Arabic (740), fewer in Judaeo-Arabic
16 Richler, op. cit. (note 10), 60–4; Isaacs, op. cit. (note 13); Niessen and Lev, op. cit. (note 13).
17 John Rylands University Library, A Guide to Special Collections of The John Rylands University Library
of Manchester (Manchester: John Rylands University Library, 1999); Efraim Lev and Renate Smithuis, ‘A
Preliminary Catalogue of the Medical and Para-medical Manuscripts in the Rylands Genizah Collection,
Together with the Partial Edition of Two Medical Fragments (B 3239 and A 589)’, Journal of Semitic Studies
(forthcoming).
18 Efraim Lev, ‘A Catalogue of the Medical and Para-Medical Manuscripts in the Mosseri Genizah Collection,
together with several unpublished examples (X.37; I.124.2)’, Journal of Jewish Studies, 62 (2011), 121–45.
19 Efraim Lev, ‘Work in progress – the research of medical knowledge in the Cairo Genizah – past, present
and future’, in Shulie Reif (ed.), The Written Word Remains: The Archive and the Achievement (Cambridge:
University of Cambridge Library, 2004), 37–51.
20 Prescription in this article is defined as practical remedy (written by practitioners for a patient), while recipe is
the ‘theoretical’ form, ie. formula of remedy found in books and notebooks. About practical prescription found
in the Genizah see: Efraim Lev, ‘Medieval Egyptian Judaeo-Arabic Prescriptions (and Edition of Three Medical
Prescriptions)’, Journal of Royal Asiatic Society, 18, 4 (2008), 449–64; Leigh Chipman and Efraim Lev, ‘Arabic
Prescriptions from the Cairo Genizah’, Asian Medicine, 6 (2011), 75–94.
21 Efraim Lev, ‘Drugs Held and Sold by Pharmacists of the Jewish Community of Medieval (11th–14th centuries)
Cairo According to Lists of Materia Medica Found at the Taylor–Schechter Genizah Collection, Cambridge’,
Journal of Ethnopharmacology, 110 (2007), 275–93; Amir Ashur and Efraim Lev, ‘New Genizah Documents:
Three Fragments on Practical Medicine in Medieval Egypt’, Ginzie Qedem, 9 (2013), 9*–35*.
22 Efraim Lev and Zohar Amar, ‘Practice Versus Theory: Medieval Materia Medica According to the Cairo
Genizah’, Medical History, 51 (2007), 507–26.
23 Peter M. Jones, ‘Harley MS 2558: a fifteenth-century medical commonplace book’, in Margaret R.
Schleissner (ed.), Manuscript Sources of Medieval Medicine (New York/London: Garland, 1995), 35–54.

492 Efraim Lev
(470)24 and the rest in Hebrew (150). About sixty titles of medical books have been
identified so far: thirty-five titles by Isaacs,25 about fifteen more titles by my Cambridge
team,26 another dozen of titles in other Genizah collections around the world and the work
of identification is still an ongoing process. Of the titles already identified, roughly one
third of the books were written by classical authorities such as Galen and Hippocrates and
another third were written by Muslim writers such as S¯
ab¯
ur Ibn Sahl (ninth century),27
Ibn S¯
ın¯
a (tenth–eleventh century), al-R¯
az¯
ı, Ibn al-Bayt
.¯
ar (thirteenth century) and ’Al¯
ı
Ibn ’Isa (tenth–eleventh century). The rest were written by Jewish physicians, members
of the Cairo Jewish community, such as K¯
uhin al-’At
.t
.¯
ar al-Isr¯
a’¯
ıl¯
ı (a thirteenth century
Jewish physician active in Egypt),28 Daw¯
ud Ibn Ab¯
ı al-Bay¯
an (a twelfth–thirteenth century
Karaite physician active in Cairo; see figure 1)29 and Maimonides (twelfth century).30
Further titles of medical books used by members of the medieval Jewish community of
Cairo can be found in the lists that record the books owned by medical practitioners or
private persons and that had subsequently been sold after their death. A few dozen of such
lists, all written in Judaeo-Arabic, include information on medical books and are being
currently studied.32 One special and unique list of books that belonged to a local Jewish
physician has been published.33
Medical books include subjects such as physiology, methods of diagnosis, healing
doctrines and so on. They also include suggested recipes for the treatment of various
diseases and ailments and information regarding medicinal substances, the quality and
uses of which were accredited to known practitioners. I would like to argue that the
medical books identified as such in the Cairo Genizah belong to the category of theoretical
medical literature. The study of this medical literature can teach us about the quantities,
24 Judaeo-Arabic is a collection of Arabic dialects spoken by Jews living in Arabic-speaking countries. See,
Joshua Blau, The Emergence and Linguistic Background of Judaeo-Arabic: A Study of the Origins of Neo-Arabic
and Middle Arabic, 1st edn (Oxford: Oxford University Press, 1965); 3rd edn (Jerusalem: Ben-Zvi Inst., 1999);
Joshua Blau, Studies in Middle Arabic and its Judaeo-Arabic Variety (Jerusalem: Magnes Press, 1988).
25 Isaacs, op. cit. (note 13).
26 Lev, op. cit. (note 20).
27 Efraim Lev and Leigh Chipman, ‘A Fragments of Judeo-Arabic Manuscripts of S¯
ab¯
ur Ibn Sahl al-Aqr¯
ab¯
adh¯
ın
al-S
.agh¯
ır Found in the Taylor–Schechter Cairo Genizah Collection’, Medieval Encounter, 13 (2007), 347–62;
Leigh Chipman and Efraim Lev, ‘Take a Lame and Decrepit Hyena.. . . A Genizah Study of Two Additional
Fragments of Manuscripts of S¯
ab¯
ur Ibn Sahl al-Aqr¯
ab¯
adh¯
ın al-S
.agh¯
ır’, Early Science and Medicine, 13 (2008),
361–83.
28 Leigh Chipman and Efraim Lev, ‘Syrup from the Apothecary’s Shop: A Genizah Fragment Containing one of
the Earliest Manuscripts of Minhaj al-dukkan’, Journal of Semitic Studies, 50 (2006), 137–67.
29 Daw¯
ud Ibn Ab¯
ı al- Bay¯
an, al-Dust¯
ur al-B¯
ım¯
arist¯
an¯
ı(Arabic), in Paul Sbath (ed.) ‘Le Formulaire des hˆ
opitaux
d’Ibn abil Bayan, m´
edicin du bimaristan annacery au Caire au XIIIe si`
ecle’, Bull´
etin de l’Institut d’Egypte,
15 (1932–3), 9–78. See Efraim Lev Leigh Chipman and Friedrich Niessen, ‘A Hospital Handbook for the
Community: Evidence for the Extensive Use of Ibn Ab¯
ı ’l-Bay¯
an’s al-Dust¯
ur al-B¯
ım¯
arist¯
an¯
ıby the Jewish
Practitioners of Medieval Cairo’, Journal of Semitic Studies, 53 (2008), 103–18.
30 Samuel Miklos Stern, Corpus Codicum Hebraicorum Medii Aaevi (Hafniae: Sumptibus E. Munksgaard, 1956),
Part 1, Vol. 3, 12–17; Shlomo Dov Goitein, ‘Maimonides Life in the Light of the Geniza Documents’, Peraqim,
4 (1966), 29–42.
31 For more details, see Lev, Chipman and Niessen, op. cit. (note 29); for transcription and translation, see
Niessen and Lev, op. cit. (note 13).
32 Miriam Frenkel, ‘Book Lists from the Genizah as a source for the culture and social history of the Jews in
Mediterranean society’, in Mordechai Friedman (ed.), A Century of Genizah Research, Te’uda, XV (Tel Aviv:
Tel Aviv University Press, 1999) (Hebrew); Nehemiah Allony, The Jewish Library in the Middle Ages: Book
Lists from the Cairo Genizah, Miriam Frenkel, Haggai Ben-Shammai with the participation of Moshe Sokolow
(eds) (Jerusalem: Makhon Ben-Zvi le-h
.ek
.er K
.ehilot Yi´
sra’el ba-mizrah
., 2006) (Hebrew).
33 David H. Baneth, ‘A Doctor’s Library in Egypt at the Time of Maimonides’, Tarbiz, 30 (1961), 171–85.

Mediators between Theoretical and Practical Medieval Knowledge 493
Figure 1: Page of a medical book: Daw¯
ud Ibn Abi al-Bay¯
an’s al-Dust¯
ur al-B¯
ım¯
arist¯
an¯
ı(T–S NS 297.56).31
qualities and level of medical knowledge that was available to the medical students and
practitioners of that time or, in other words, could be termed as their ‘intellectual medical
workshop’. According to Jones, medieval books, especially in England and Europe, were
usually large and lengthy tomes, expensive to buy and not very portable. They could not
be used for quick reference purposes because it would be difficult to access the required
information,34 since most of the information about medication and ailments was often
scattered in large tomes, for example in Ibn S¯
ın¯
a (Avicenna)’s Canon.35
34 Jones, op. cit. (note 23), 36.
35 Ibn S¯
ın¯
a, Ab¯
u ’Al¯
ı al-H
.usayn b. ’Abdall¯
ah. al-Q¯
an¯
un f¯
ı ’l-t
.i bb (Beirut: D¯
ar al-Kutub al-’Ilmiyya, 1999);
Nancy G. Siraisi, Avicenna in Renaissance Italy. The Canon and Medical Teaching in Italian Universities after
1500 (Princeton: Princeton University Press, 1987), 21–3.

494 Efraim Lev
From the methodological point of view, and according to my experience, medical books
in general are distinguishable from the medical fragments found in the Genizah by certain
unique features:
•The text in the medical books is usually longer than in prescriptions, letters and
notebooks;
•In most cases the page layout is nicely done, the text is well set out and written in a
professional style in a clear and fine handwriting, the number of lines is fixed, and the
margins are straight;
•The text is written on both sides of the paper and occasionally on bi-folium;
•All fragments that are pages of the same book are of the same size;
•The text is written by one hand and in one language;
•The text is usually written in the same colour ink (apart from important words or
headings written in some cases in other colours);
•Occasionally, a catchword36 is presented at the bottom of each page;
•The text is organised in book form, with volume, chapter and section headings.37
B. Practical or ‘clinically useful medical knowledge’ is commonly found in
prescriptions, lists of drugs and private correspondence written by medical practitioners
such as physicians and pharmacists as part of their daily work. This comprised treating
patients or preparing drugs. Such documents, mainly prescriptions, record their actual
work and consequently can be considered an important element of medical knowledge in
its practical form.38
Prescriptions form the main bulk of the fragments of a practical character. There are 141
unique original prescriptions in the T–S Genizah collection, of which thirty were more
or less complete:39 eighty-three written in Arabic (see for example figure 2), fifty-six in
Judaeo-Arabic,40 one in Judaeo-Persian and one in Hebrew.41 A few more were discovered
in the other collections.
Only a few prescriptions were copied identically, others contained changes derived from
famous books such as Minh¯
aj al-Dukk¯
an43 or al-Dust¯
ur al-B¯
ım¯
arist¯
an¯
ı.44 One special
36 A word written at the bottom of a page that repeats the first word of the following page.
37 For codicological terminology used in this work see: Adam Gacek, Arabic Manuscripts: A Vademecum for
Readers (Leiden/Boston: Brill, 2009); Franc¸ois D´
eroche, Islamic Codicology: an Introduction to the Study of
Manuscripts in Arabic Script, Deke Dusinberre and David Radzinowicz (trans.), in Muhammad Isa Waley (ed.)
(London: Al-Furq¯
an Islamic Heritage Foundation, 2006); Malachi Beit-Aria, Hebrew Codicology: Tentative
Typology of Technical Practices Employed in Hebrew Dated Medieval Manuscripts (Jerusalem: Israel Academy
of Sciences and Humanities, 1981).
38 Efraim Lev and Zohar Amar, ‘Reconstruction of the Inventory of Materia Medica used by Members of
the Jewish Community of Medieval Cairo According to Prescriptions Found in the Taylor–Schechter Genizah
Collection, Cambridge’, Journal of Ethnopharmacology, 108 (2006), 428–44.
39 Efraim Lev and Leigh Chipman, Medical Prescriptions in the Cambridge Genizah Collections: Practical
Medicine and Pharmacology in Medieval Egypt (Leiden: Brill, 2012).
40 The figures here are different from previous publications since, as in other research projects, our Genizah
study is a dynamic process. In the last three years, several additional fragments in Arabic script have been
identified as prescriptions, while several Judaeo-Arabic documents formerly considered to be prescriptions have
been reclassified as notebooks.
41 For a full discussion of these, see Lev, op. cit. (note 19); Chipman and Lev, op. cit. (note 19); Efraim Lev and
Zohar Amar, Practical Materia Medica of the Medieval Eastern Mediterranean According to the Cairo Genizah
(Leiden: Brill, 2008), 43–8.
42 A full edition of this fragment is published in Lev and Chipman, op. cit. (note 39), pp. 52–4.
43 al-K¯
uhin al-’At
.t
.¯
a
.r, Abu ’l-Mun¯
a D¯
aw¯
ud b. Ab¯
ı Nas
.r. Minh¯
aj al-dukk¯
an wa-dust¯
ur al-a’yan f¯
ı a’m¯
al wa-tar¯
ak¯
ıb
al-adwiya al-n¯
afi’a li-’l-ins¯
an. H
.. al-’ ¯
As¯
ı
.(ed.) (Beirut: D¯
ar al-Man¯
ahil, 1992).
44 al-Bay¯
an, op. cit. (note 29).

Mediators between Theoretical and Practical Medieval Knowledge 495
Figure 2: Practical prescription (T–S Ar.39.458).42
prescription written for a dozen patients was also discussed in a separate publication.45 A
unique aspect of the information that emerges from the prescriptions is their originality.
Unlike the information derived from books which is usually copied from classical or
45 Efraim Lev, Leigh Chipman and Friedrich Niessen, ‘Chicken and Chicory are Good for You: A Unique Family
Prescription from the Cairo Genizah (T–S NS 223.82–3)’, Jerusalem Studies in Arabic and Islam, 35 (2008),
335–52.

496 Efraim Lev
contemporary medical sources, the prescriptions are clear-cut primary evidence for the
medicinal substances actually in use, 242 of which are mentioned. These prescriptions
can therefore be considered as solid evidence of the use of these substances for medicinal
purposes and of medical knowledge in its practical form.46
The features which enabled us to identify Genizah fragments as prescriptions have
already been discussed in previous publications.47
Prescriptions can also teach us about the prevailing diseases and their symptoms that
were actually suffered by members of the community.48
Prescriptions are rarely preserved since they lose their importance the moment they
are used; finding such documents in the Genizah can be described as the ‘survival of
ephemeral documents’. It is a rare opportunity for historians of medicine to be able to read
and analyse records of the immediate interaction between the physicians who wrote out
the prescriptions and their patients who presumably took the prescriptions to apothecaries
for the purchase or preparation of the formula. The prescriptions are in fact autographs
from the prescribing physicians themselves. They come about as close to the ipsissima
verba of medieval physicians as we are likely to get. It is a reflection of the medical
reality that actually existed, which at times corresponds with the information found
in books.
Previous research in the history of medicine in the Genizah clearly show that the
practical inventory of materia medica was smaller (278) than the theoretical inventory
(414), which was based on the books that physicians possessed. In other words, the
Genizah allows us for the first time to quantify the difference between the practical and
theoretical inventories which comes to 136 simple drugs (33%).49
Presented below is a plethora of Genizah fragments consisting of medical notebooks
that, thanks to the quantity of the documents, their originality and the historical knowledge,
comprise a unique source of historical data from which scholars can learn and better
understand the way medieval Arab medical knowledge was transferred from theory to
practice and vice versa. This specific genre has hardly been known or dealt with in research
to date. An attempt will therefore be made here to elucidate the following questions that
will allow us to place the documents within the context of this medieval community and
of Mediterranean society in general during that particular period:
•Who wrote the medical notebooks found in the Cairo Genizah, for what purpose and
what was their language of preference?
•Where did the recipes in the notebooks originate from?
•What kind of medical knowledge was recorded in the medical notebooks and what were
the main medical topics that were of concern to them?
46 Lev and Amar, op. cit. (note 38).
47 Most of the prescriptions were written on one page, usually on one side of the sheet of paper and very rarely
on vellum, and in one case even on a piece of cloth. Prescriptions were often written on reused paper, sometimes
in the margin or in between the lines of other documents or even books. The handwriting is usually sloppy and
unclear; see Lev and Amar, op. cit. (note 41), 45–6.
48 Analysis of the prescriptions with the help of contemporary pharmacopoeias shows that eye diseases were the
most prevalent ailments. Other ailments were skin diseases, headaches, fevers, internal diseases (liver), intestinal
problems, and haemorrhoids, urinary problems, ulcers, swellings, cough and gynaecological illnesses; see ibid.,
46–7.
49 Ibid., 550–8.

Mediators between Theoretical and Practical Medieval Knowledge 497
Medical Notebooks in the Cairo Genizah
Sixty-one medical notebooks were identified: fifty in the T–S Genizah collection,50
nine in the Mosseri collection,51 and two in the John Rylands University Library in
Manchester.52 This is roughly 3% out of about 2040 medical fragments that are found
in these collections.53
Discussion
A notebook in the modern sense is a booklet of plain paper used for writing notes.54 Such
booklets were already used in ancient Greece in parchment form. One early example is
Pliny’s first century description of the ‘private notebook’ of Mithridates found by Pompey
which included a prescription for the famous antidote against poisoning.55
In early Islamic times the word daftar56 seems to have been used to denote the codex
form of a book or booklet, as opposed to rolls and loose sheets. With the development
of elaborate bureaucratic organisations, the keeping of daftars became a task calling for
special skills and knowledge and consequently daftars of many different varieties began
to emerge.57
Very little is written about notebooks in the Arabic scholarly tradition in contrast
with the vast literature dealing with books.58 Gunther mentions that, as part of the oral
and written transmission of knowledge, teachers in Early Islam based their lectures and
seminars on “‘collections” of data and “lecture scripts”’ that were organised in notebook
form.59 As an example of this, he suggests that Ab¯
u l-Faraj al-’Isfah¯
an¯
ı (tenth century),
50 T–S K14.32; T–S K25.83; T–S Ar.11.11; T–S Ar.35.226; T–S Ar.39.20; T–S Ar.39.367; T–S Ar.39.451;
T–S Ar.42.20; T–S Ar.42.67; T–S Ar.43.28; T–S Ar.43.42; T–S Ar.44.30; T–S Ar.44.182; T–S Ar.44.222; T–S
Ar.45.21; T–S Ar.45.30; T–S Ar.45.40; T–S Ar.50.171; T–S AS 147.204; T–S AS 148.111; T–S AS 150.136;
T–S AS 159.235; T–S AS 160.197; T–S AS 163.199; T–S AS 179.262; T–S Or.1080 7.17; T–S Or.1081.1.78;
T–S NS 90.23; T–S NS 90.51; T–S NS 90.64; T–S NS 90.73; T–S NS 90.74; T–S NS 91.6; T–S NS 163.116;
T–S NS 164.159; T–S NS 190.26; T–S NS 224.146; T–S NS 224.149; T–S NS 224.226; T–S NS 225.108; T–S
NS 264.27; T–S NS 265.27; T–S NS 265.62; T–S NS 297.48; T–S NS 314.6b; T–S NS 322.31; T–S NS 324.128;
T–S NS 339.62; T–S NS J89; T–S NS J 543.
51 I, 111; I, 112; I, 113; I, 114.2; I, 126.1; I, 127.1; I, 127.2; I, 128.1; IV, 339.2.
52 B 3238-1-2; B 3239-1-2.
53 However, as mentioned before some fragments are very small and they might be from books (eg., TS NS
90.73 and TS NS 90.74). The same holds for more fragments identified as notebooks, but being well arranged
and set may likewise be from books (T–S Ar.44.182; T–S Ar.45.187, T–S Or.1080.7.17; T–S AS 148.28; T–S
NS 190.26; T–S NS 210.29).
54 Oxford Paperback Dictionary: Thesaurus, and Wordpower Guide (Oxford, 2001), 604; Cambridge Dictionary
online (http://dictionary.cambridge.org/).
55 Pliny, Natural History, XXIII, 77: 149, William H.S. Jones (trans.) (Cambridge, Mass./London: Heinemann,
1969), 515.
56 In the Arabic tradition daftar is described as ‘a stitched or bound booklet or register.. .an account or letter-
book used in administrative offices.. . ’ see Bernard Lewis, ‘Daftar’, Encyclopaedia of Islam, 2nd edn, in P.
Bearman, Th. Bianquis, C.E. Bosworth , E. van Donzel and W.P. Heinrichs (eds) (Leiden: Brill, 2010), II, 77.
57 Ibid.
58 George Nicholas Atiyeh (ed.), The Book in the Islamic World: the Written Word and Communication in the
Middle East (Albany: Library of Congress, 1995); Jonathan M. Bloom, Paper before Print: the History and
Impact of Paper in the Islamic World (New Haven/London: Yale University Press, 2001); Johannes Pedersen,
The Arabic Book, Geoffrey French (trans.) (Princeton: Princeton University Press, 1984); D´
eroche, op. cit. (note
37).
59 Sebastian Gunther, ‘Assessing the Sources of Classical Arabic Compilations: The Issue of Categories and
Methodologies’, British Journal of Middle Eastern Studies, 32, 1 (2005), 75–99, 78.

498 Efraim Lev
when writing his book Maq¯
atil at-T
.alib¯
ın [The Killing of the Talibids],60 used notebooks
that al-Thaqaf¯
ı (tenth century) had written.61 Similarly, Ab¯
u l-Faraj al-Isfah¯
an¯
ı sometimes
quotes at length from al-Nawfal¯
ı (ninth century); according to Gunther these passages may
have been drawn from his teacher’s works or even from the notebooks he prepared when
he was a student.62 Al-T
.abar¯
ı (ninth–tenth century) also relied on presumably unpublished
‘books’ when transmitting information: ‘Like other students and scholars, al-T
.abar¯
ı kept
his notebooks and occasionally made a reference to them’.63 Another case is Ab¯
u H
.ayy¯
an
al-Tawh
.¯
ıd¯
ı (tenth century), who ‘burned his books at the end of his life. . . .’ According to
Rosenthal these include unpublished manuscripts, such as notebooks and drafts.64
A few scholars discussed the issue of ‘household books’ that circulated within the lay
realm in medieval England. Boffey for example described such books as ‘A repository
of practical information of more or less domestic kinds – recipes and remedies and
instructions on matters such as dyeing, fishing. . ..’65 A similar genre for such books was
known in the West and termed by several scholars as ‘commonplace books’. Some of
these fifteenth-century manuscripts in England were studied, and according to Jones the
way that some of them were compiled ‘throws a great deal of light on the integration of
practical experience. . .with the fruits of his own reading of medical texts’.66
In Europe, ‘commonplace books’ were used by Renaissance scholars in a similar way
for collating and preserving poems written by a large number of poets. In most cases,
neither the owners’ nor the poets’ names were recorded. According to Thomas, such
‘commonplace books’ were dynamic in character and always receptive to a new poem or
the improvement of an existing one. He also states that these, ‘are about memory. . .like a
record of what that memory might look like’.67 According to Blair, ‘commonplace books’
in the Renaissance were used as a ‘humanistic method of reading and storing information’.
The method, similar to that of our medical notebooks, was to select passages of interest,
dialectical arguments, or factual information, and copy them for later use. Blair also asserts
that the method was learnt from the classical science of rhetoric and had a similar use
in medieval times when it also served, as ‘in the case of medical handbooks’, to record
‘recipes compiled for easy access’.68 Schiffman adds that quite often separate notebooks
60 Sebastian Gunther, ‘Maqatil-Literature in Medieval Islam’, Journal of Arabic Literature, 25, 3 (1994),
193–212.
61 Ibid., 193.
62 Sebastian Gunther, ‘Al-Nawfal¯
ı’s Lost History. The Issue of a 9th Century Shiite Source Used By al-T
.abari
and Abu l-Faraj’, British Journal of Middle Eastern Studies, 36.2 (2009), 241–66, 252, 263.
63 Gunther, op. cit. (note 62), 263; al-Tabar¯
ı, General Introduction, and, From the Creation to the Flood, Franz
Rosenthal (trans.) (Albany, 1989), I, 6, 52.
64 Franz Rosenthal, “‘Of making many books there is no end”: the classical muslim view’, in George Nicholas
Atiyeh (ed.), The Book in the Islamic World (Albany: State University of New York Press, 1995), 33–70, at p.
40 (note 47).
65 Julia Boffey, ‘Bodleian Library MS Arch. Selden. B.24 and definitions of the “household book”’, in Edwards
Gillespie and Ralph Hanna (eds), The English Medieval Book: Studies in Memory of Jeremy Griffith (London:
British Library, 2000), 125–34.
66 Jones, op. cit. (note 23), 36–7.
67 Max W. Thomas, ‘Reading and Writing the Renaissance Commonplace Book: A Question of Authorship’,
Cardozo Arts and Entertainment, 10 (1992), 665–79.
68 Ann Blair, ‘Humanist Methods in Natural Philosophy: the Commonplace Book’, Journal of the History of
Ideas, 53 (1992), 541–51.

Mediators between Theoretical and Practical Medieval Knowledge 499
‘record a wide range of realia or interesting bits of general information sorted under
appropriate subject headings according to the topics and themes addressed’.69
Another genre of European medieval manuscripts was termed ‘booklet’. The ‘booklet’
was described as a ‘self contained unit. .. originated as a small but structurally independent
production containing a single work or a number of short works’.70 According to Robinson
the ‘booklet’ was a third type of manuscript unit: the first type being the ‘quire’, which
was a gathering of conjoint leaves secured one within the other by sewing them together,
and the second being the ‘pecia’, which can be found in European university manuscripts.
A unique genre of medical handbook named Tabula Medicine was in use from
the fourteenth century in England. This was a lengthy Latin medical text organised
alphabetically by headings, and space was left after each entry for expansion and
addition by subsequent generations of practitioners and users of the manuscript.71 Another
medieval use or genre of notebooks was identified and described by Bos and Mensching
who recorded dozens of medical glossaries (synonyms of medicinal substances and
terms) written in Hebrew, Judaeo-Arabic, Persian, Ladino, Yiddish and other languages.72
Interestingly enough, we found only one such glossary in the UK Genizah collections.73
Thus, throughout history, all of the various genres of notebooks and their contents,
including prescriptions, seem to have been intended for personal use; they are usually
shorter than books, untidy and often written in a barely legible scrawl.
In examining the medical notebooks discovered in the Genizah we find evidence
of unique features that distinguish them both from other medical books and practical
prescriptions:
•The text in notebooks is actually longer than in prescriptions and contains a few or
many recipes;
•The external dimension is on average smaller than that of the medical books; in many
cases, parts of the fragments are written in a different handwriting,74 sometimes in
different kinds of ink;
•The recipes in the notebooks have names and do not usually have blessings
(benedictions), which is similar to what is found in books but unlike practical
prescriptions;75
•The absence of blessings indicates that the recipes in notebooks were written in order
to record the recipes and not to instruct the pharmacists how to prepare the formulae
and use them for treating patients on the spot;
69 Zachary Schiffman, ‘Montaigne and the Rise of Skepticism in Early Modern Europe: A Reappraisal’, Journal
of the History of Ideas, 45 (1984), 504–5.
70 P.R. Robinson, ‘The “Booklet”, A Self-contained Unit in Composed Manuscripts’, Codicologica, III (1980),
46–69.
71 This early ‘Wiki’ style medical book is described in details in Peter M. Jones, ‘The Tabula Medicine: an
Evolving Encyclopedia’, A.S.G. Edwards (ed.) English Manuscripts Studies, 14 (2008), 60–85.
72 Gerrit Bos and Guido Mensching, ‘The Literature of Hebrew Medical Synonyms: Romance and Latin Terms
and their Identification’, Aleph, 5 (2005), 169–211; Gerrit Bos and Guido Mensching, ‘Shem Tov Ben Isaac,
Glossary of Botanical Terms nos. 1–18’, Jewish Quarterly Review, 92 (2001), 21–40.
73 Efraim Lev and Zohar Amar, ‘A Medieval Judaeo-Arabic Glossary of Drug’s Names in the Taylor–Schechter
Genizah Collection, Cambridge’, Journal of Semitic Studies (forthcoming).
74 Mosseri I.124.2; Mosseri I, 127.2; Mosseri IX.118; T–S K 25.83; T–S Ar. 35.226; T–S Ar. 43.56; T–S Ar.
45.40; T–S AS 148.111; T–S NS 224.149.
75 T–S Ar. 42.67; T–S Ar. 45.40.

500 Efraim Lev
•Occasionally the overleaf is blank,76 and sometimes the verso is inverse to the recto
(the ‘top’ of one side is the ‘bottom’ of the other);77 in other cases the content of the
verso differs completely from the recto78 even when they both deal with medicine (for
example, in one case,79 an Aramaic ketuba appears on the back of the fragment; the
common practice of recycling (secondary use) of writing materials is evident in this
instance);
•Sometimes the content on one side is divided into two to four columns,80 in one case
the recipes were crossed out;81
•In most cases, the text is written in a vulgar style and is scrawled,82 while the line
arrangement is usually sporadic and unfixed, with margins of various sizes, similar to
prescriptions and different from the books.83
The majority (forty-nine) of the medical notebooks found in the Genizah are written
in Judaeo-Arabic, which undoubtedly was the vernacular at the time and clearly attests to
the fact that these notebooks were written and used by Jewish practitioners. Only a few
notebooks (eight) were written in Arabic and one in Hebrew. In other cases the content
is in multiple languages (Hebrew, Arabic and Judaeo-Arabic).84 Some notebooks were
written on vellum.85
The study of Genizah medical notebooks and their analysis led me to draw the following
diagram in which I have attempted graphically to locate our documents between the
theoretical literature and the medical practice of the practitioners in medieval Cairo
(figure 3).86
As mentioned at the beginning of the article, the main question which puzzled me was
who wrote those medical notebooks found in the Genizah, and for what purpose. From
studying the history of notebooks and their uses throughout the ages in general and the
medical notebook in particular, I suggest the following options:
•The medical notebooks of the Genizah might have been the way the Jewish Cairene
practitioners (physicians or pharmacists) kept their favourite recipes which were
acquired from other physicians [A – in the diagram of figure 3] and medical books
[D], or recorded when practising in local hospitals [B];
•They might have been written by medical students who recorded the medical
knowledge of their preference which they learnt from reading books [D] or picked
up orally from famous physicians with or under whom they worked [A]. An earlier
(classical) feature that was found in a Pseudo-Galen book, Avoiding Grief, strengthens
the last two options. In chapters thirty-two and thirty-three the author describes how he
collected the recipes he includes in his book. He comments on his good fortune in being
76 Mosseri I, 113; T–S Ar. 45.40; T–S NS 90.64; T–S NS 163.116; T–S NS 164.159; T–S NS 324.128; T–S NS
339.62.
77 Mosseri I, 127.1; Mosseri I, 127.2; T–S NS 91.6; T–S NS 224.226; T–S NS 265.62.
78 Mosseri I, 114.2; Mosseri I, 127.1; Mosseri I, 127.2; T–S K 25.83; T–S Ar. 39.451; T–S Ar. 45.21; T–S AS
148.111.
79 T–S NS 264.27.
80 T–S Ar. 39.451; T–S NS 90.64; T–S NS 264.27.
81 T–S Ar. 35.226.
82 T–S NS 225.108.
83 T–S Ar. 45.40.
84 Mosseri, I, 126.1; Mosseri I, 127.1; T–S NS 91.6; T–S NS 164.159.
85 NS 163.116; NS 265.62; Ar. 50.171; Or. 1080 7.17; T–S NS 224.226.
86 The purpose of the diagram is to enlighten the discussion and the conclusion and vice versa.

Mediators between Theoretical and Practical Medieval Knowledge 501
Figure 3: Practical medical notebooks: a diagram.
able to obtain most of the prescriptions from a rich man in Asia Minor who planned to
assemble the best collection of recipes in the world, mainly copied from parchments;87
•Medical knowledge, mainly recipes, was collected by ordinary people. During this
period they may have taken a great interest in medicine and some families might have
owned notebooks filled with medical advice and recipes for their personal use [C];88
•Traditional healers89 were another group of community members who collected such
recipes in notebooks for their professional needs and use. Jones, who studied late
medieval English medical and commonplace books, wrote on this issue:
It will be as well to remember that medical practice was not just for professionals. It was not
monopolized by those for whom medicine was a way of making a living. Nor were medical
practitioners the only people who recorded information in manuscripts. Consequently it gives us
invaluable insight into medical practice.90
This argument stands in our favour since it applies to people in general beyond the more
familiar boundaries of time and location. For example, in early modern Yemen, many
Jewish families had similar medical notebooks that sometimes included traditional
medical knowledge.91
Traditional medical writing has been described by Barkai in reference to Spain and
North Africa. He states that traditional medicine was not necessarily or exclusively the
87 Veronique Boudon-Millot, ‘Un trait´
e predu de Galien miraculeusement retrouv´
e, le sur l’inutilit´
e de
se chagriner: Texte Greg et Traduction Francaise’, in Veronique Boudon-Millot, Guardasole Alessia and
Magdelaine Caroline (eds), La Science M´
edicale Antique, Nouveaux Regards (Paris: Beauchesne, 2007), 73–123.
at 111.
88 Allony, op. cit. (note 32).
89 Practitioners using knowledge, skills and practices based on the local indigenous experience – in opposition
to the learned, licensed doctors.
90 Peter M. Jones, ‘Witnesses to Medieval Medical Practice in the Harley Collection’, Electronic British Library
Journal (2008), 1–13.
91 Proffesor Zohar Amar, personal communication (November 2010).

502 Efraim Lev
domain of ordinary people, and that whoever wrote traditional medical works most
probably did not belong to the lower strata of society.92 Barkai also differentiates
between traditional medical writing and medical books according to the following
characteristics:
•Traditional medical writings, including classical and medieval, neither cite nor mention
learned medical sources;
•In traditional medicine, the treatment of all diseases and conditions never includes
surgical procedures;
•Traditional medicine gives no indication of weights or measures;
•Traditional medicine does not include magic symbols, spells, prayers, or oaths.93
From an analysis of our notebooks, most of them seem to contain learned medical
knowledge.94
A systematic search through Arabic medical books for the source of the recipes found
in the notebooks revealed only a few recipes copied from books [D], for example, T–S
NS 297.48 from al-K¯
uhin al-’At
.t
.¯
ar al-Isr¯
a’¯
ıl¯
ı, Minh¯
aj al-Dukk¯
an wa-Dust¯
ur al-’A’y¯
an
f¯
ı ’A’m¯
al wa-Tar¯
ak¯
ıb al-’Adwiya al-N¯
afi’a li-l-’Ins¯
an;95 and from S¯
ab¯
ur Ibn Sahl, al-
Aqr¯
ab¯
adh¯
ın al-s
.agh¯
ır (The Small Dispensatory), T–S Ar.44.187, recipe no. 236;96 and
T–S Ar.45.40, recipe no. 204.97 The source for a greater majority of the recipes was
not found in printed books or manuscripts. One explanation could be that those recipes
were original, perhaps concocted by the notebook owners from their own experience [C].
Another explanation could be that those recipes were passed on to students by word of
mouth from their teachers, from other practising physicians or at the hospitals where
they worked. In any case, like the point made by Andorlini after studying 260 Egyptian
medical papyri of the Classical period, these recipes may have been based not solely on
the classical or Arabic medical traditions, but also on local pharmacopoeias, ‘developed
through inaccuracy or alteration over the centuries’.98
A few scholars have raised a number of questions regarding medical notebooks and
compendiums of a similar genre. Although they studied notebooks from other periods or
different geographical regions, I have noted their questions and will try to reply to them
from our experience with the Genizah notebooks. Fortunately enough we can deal with
and answer most queries when discussing our findings. When Totelin discussed Pliny’s
description of the ‘private notebook’ of Mithridates found by Pompey and said that it
included a prescription for an antidote,99 she raised the following questions:
Was it the original recipe of Mithridatium? Was it the only recipe contained in the notebook? Was the
notebook translated into Latin? Did Pliny have direct access to the notebook or is he reporting something
he read, or heard about? . . .Was this notebook genuinely recorded by Mithridates or a forgery?
92 Ron Barkai, Science, Magic and Mythology in the Middle Ages (Jerusalem: Van Leer Institute, 1987),
(Hebrew), 62.
93 Ibid., 64–5.
94 For example, T–S K 14.32; T–S Ar. 39.20.
95 al-’At
.t
.¯
ar, op. cit. (note 43).
96 S¯
ab¯
ur Ibn Sahl, Dispensatorium parvum (al-Aqr ¯
ab¯
adh¯
ın al-s
.agh¯
ır), in Oliver Kahl (ed.), (Leiden/New York-
K¨
oln: Brill, 1994), 145; Oliver Kahl (ed. and trans.), S¯
ab¯
ur Ibn Sahl The Small Dispensatory (Leiden/Boston:
Brill, 2003), 123.
97 S¯
ab¯
ur Ibn Sahl, op. cit. (note 96), 132–3; Kahl, op. cit. (note 96), 113.
98 Andorlini, op. cit. (note 8), 23–33.
99 Pliny, op. cit. (note 55), 515.

Mediators between Theoretical and Practical Medieval Knowledge 503
‘Unfortunately’, Totelin wrote, ‘it is impossible to answer these questions’.100
The medical notebooks identified in the Cairo Genizah collections are not as old as the
one mentioned by Pliny, neither do they correspond to such well-known and important
historical figures such as Mithridates, Pompey and Pliny. However, they fortunately do
supply us with answers to most of Totelin’s questions since the recipes in our notebooks
are clearly original with only few of them copied from medical books. Moreover, each
notebook contained a few recipes which were genuinely recorded and were used by Jewish
practitioners in medieval Cairo most of whom are still anonymous.
After studying many Old and Middle English manuscripts of ‘household books’ and
medical books, Green raised many questions including the following: ‘Wouldn’t women
have had access to books in their husbands’ libraries, and might not “household books”
have been a venue in which men and women might equally share access to medical
knowledge?’. Indeed, medical texts and recipes figure as common elements in many
‘household books’, and in quite a few there are ‘vast numbers of gynaecological and
obstetrical remedies’.101 With regard to this we should point out that among the 61
Genizah medical notebooks found so far, which are dated a few centuries earlier than the
‘household books’ studied by Green; only one deals with gynaecological conditions.102
I therefore suggest that the Genizah notebooks were not written by or for women even
though Jewish women might have had access to the medical books and notebooks in their
household in medieval Cairo, but most probably not for medical practice.103
The main contents of the Genizah medical notebooks are selected recipes, methods of
healing and medical theories [E]. The recipes and the medical knowledge collected this
way can also give us a clue as to the most prevalent diseases among the members of the
community. An analysis of the subjects mentioned in the medical notebooks offers an
insight into their daily medical life.104 The vast majority of them may be described as
pharmacopoeia and can be divided into three groups:
Recipes for the treatment of various diseases. Thirty-five notebooks were identified
as pharmacopoeia since they consist of recipes for a range of ailments. This
corroborates our finding of vast amount of pharmacopoeias (books) that were identified
in the process of studying the medical literature found in the Genizah, and the
reconstruction of the medical library of the Jewish practitioners of medieval Cairo;
Treatment of eye diseases. Two fragments were in the literary style of a
pharmacopoeia,105 but the recipes mainly concern eye diseases. They were
consequently identified as the part or chapter dealing with eye diseases in a private
100 Laurence M.V. Totelin, ‘Mithradates’ Antidote – A Pharmacological Ghost’, Early Science and Medicine, 9
(2004), 1–19.
101 Monica H. Green, Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern
Gynaecology (Oxford: Oxford University Press, 2008), 192–3.
102 T–S Ar. 45.21, dealing with treatment of women’s complaints, including menorrhagia.
103 It should be noted that Goitein briefly wrote about the role of women in medicine recorded in the Genizah, for
example ‘the little woman doctor’. According to him, these women mainly fulfilled a role in the female society of
the Genizah period, some were specialists for the removal of hair from the bodies of ladies, while others served
as midwives; Goitein, op. cit. (note 13), I, p. 127–8, III, p. 63–4, 232.
104 I intend to discuss separately some of those genres (based on fragments of books and notebooks found in the
Genizah) in future publications, mainly pharmacopeias, eye diseases, and materia medica.
105 Each pharmacopoeia in the Arabic medical literature has its own structure and order of chapters, where
formulations are grouped in various ways. In general, pharmacopoeias appear to have no truck with the head-to-
toe arrangement usually found in medical encyclopedias. In most cases they present compound drugs according
to the traditional arrangement by formulation; Levey op. cit. (note 2), 72.

504 Efraim Lev
pharmacopoeic notebook, similar to the parts found in Arabic medical books by authors
such as al-Kind¯
ı (ninth century),106 Ibn Ab¯
ı al-Bay¯
an,107 and al-K¯
uhin al-’At
.t
.¯
ar al-
Isr¯
a’¯
ıl¯
ı.108 I elaborate on this issue in the commentary to the first fragment edited below
(T–S K14.32);
Specialised recipes. A few fragments were identified as dealing with skin diseases
(two), coughs and colds (one), dentistry and oral hygiene (one), gynaecological
conditions (one), and even traditional medicine (two). Seven fragments concern the
actions and uses of simples and therefore can be described as materia medica.109
Three notebooks found in the Genizah, besides the above-mentioned pharmacopoeias
on the treatment of eye diseases, dealt with ophthalmology which is discussed in detail
below. A similar situation emerged with regard to the medical books found in the Genizah.
Other fragments concern general medical texts (not recipes) (six), dietetics (one), hygiene
(one), alchemy (one), and astrological traditional medicine (one).
As mentioned before, a unique finding is a fragment containing fifteen identified
medicinal substances and their synonyms and was described as a medical glossary.110
Very few medical authorities are referred to or quoted by the writers of the medical
notebooks in the Genizah. The few that I did find are classical authors such as Galen111 and
Arab authors such as al-R¯
az¯
ı,112 Ibn S¯
ın¯
a113 and Ibn M¯
asawyah (eighth–ninth century).114
This is unlike the practice of authors of medieval medical books, who quoted copiously
from medical authorities in their writings.115
Last but not least is the personal aspect (experience): only a few such cases were
recorded; in one example, the author of one of the recipes for the treatment of eye
diseases116 used the expression mujarrab (tried). The second example is found in the first
fragment edited below (T–S K14.32), in which the author wrote personal remarks such as
‘marvelous’ and ‘see great benefit’ like many authors of Eastern medieval pharmacopoeias
who often concluded their recipes with such remarks.117
Edition of the Genizah medical notebooks
To demonstrate the variety of medical notebooks found in the Genizah collection, I have
chosen and edited three fragments for publication written, respectively, in Hebrew, Judaeo-
Arabic and Arabic.
106 Martin Levey, The Medical Formulary or the ’Aqr¯
ab¯
adh¯
ın of al-Kind¯
ı(Madison: University of Wisconsin
Press, 1966).
107 al-Bay¯
an, op. cit. (note 29).
108 al-’At
.t
.¯
ar, op. cit. (note 43).
109 This is a well-known genre of medical books in medieval Arabic medical literature, well represented in the
reconstructed Genizah’s medical library, and of importance since the Classical period, eg., Dioscorides’ Materia
Medica, Robert Theodore Gunther (trans.), The Greek Herbal of Dioscorides (New York: Hafner Pub. Co., 1959);
Albert Dietrich, Dioscorides Triumphans. Ein anonymer arabischer Kommentar (Ende 12. Jahrh. N. Chr.) zur
Materia Medica, 1–2 (Gottingen: Vandenhoeck & Ruprecht, 1988).
110 T–S NS 224.146; Lev and Amar, op. cit. (note 76).
111 TS NS 224.226; T–S Ar. 11.11; T–S Ar. 39.367; T–S Ar. 35.226.
112 TS NS 265.27.
113 T–S Ar. 35.226.
114 T–S Ar. 11.11.
115 S¯
ab¯
ur Ibn Sahl, op. cit. (note 96), 11–2; Kahl, op. cit. (note 96), 29–30; Levey, op. cit. (note 106), 7; Chipman,
op. cit. (note 2), 18–46.
116 TS Ar. 44.30.
117 Chipman, op. cit. (note 2), 13.

Mediators between Theoretical and Practical Medieval Knowledge 505
T–S K14.32 (figure 4) – Notebook: Ophthalmology. Hebrew; semi-cursive script with
sporadic Tiberian vocalisation; paper; 1 leaf; 16.3×11.1 cm; 21–22 lines. Recipes for the
treatment of eye complaints [fifteenth–sixteenth century].118
T–S K14.32 – (recto) Text (Transcription):
T–S K14.32 – (recto) Translation:
1. To Preserve the Eye’s Health, marvelous
2. Take pomegranates sweet and sour: squeeze them
3. and put each one, alone, in the sun in a glass jar
4. and strain it every month and discard the yeast: and afterwards assemble
5. them equally together: and afterwards take to all and ??? of them
6. aloe : pepper : long pepper : sal-amoniac : of each one dirham.
7. Grind them all good and thin: throw into the juice
8. mentioned: smear on the eye : and the
9. older/riper the better: marvelous
10. and one of the physicians that tried it on himself wrote,
11. to sharpen the eyesight
12. take the juice of sour pomegranates : boil them until
118 Isaacs, op. cit. (note 13), no. 31; Rebecca J.W. Jefferson and Erica C.D. Hunter, Published Material from the
Cambridge Genizah Collections: A Bibliography 1980–97 (Cambridge: Cambridge University Press, 2004), 56.

506 Efraim Lev
Figure 4: Hebrew ophthalmologic notebook (T–S K14.32).
13. half evaporate : and afterwards add the same amount of honey :
14. boil them until mixed : place in the sun
15. twenty days : smear [the eyes] with it : and see great benefit.
16. For the whiteness of the eye tested: take goat’s beard and blood
17. of goat also and place them separately
18. in one jar : and afterwards take dates’ kernels and roots
19. and make powder : and afterwards take a fresh egg and extract its red
20. only : add some salt to it: and afterwards place
21. it all in the egg and burn it together and make

Mediators between Theoretical and Practical Medieval Knowledge 507
22. powder and put in the eye and it will extract the whiteness : with God’s help
23. Made as a dressing on the eye it will prevent leaking of it ::::
24. vine leaves and barley flour
Commentary
Certain features attest to the identification of this fragment as a notebook. First, the setting
of the information in the fragment is less formal than in a book. Second, the fragment is
eclectic in character: the recipes are not set out in any specific/systematic or logical order
(two recipes bear the name of an ailment in the first line; and one starts with ‘One of
the physicians. . .’). However, the fragment was written by a single author (one hand) and
all the recipes (three on one side and three more on the verso) are for the treatment of eye
diseases. The medicinal substances mentioned in these recipes are varied and include many
inorganic substances such as salt, animal products such as honey, goat (beard and blood)
and egg. The rest are plants (pomegranates sweet and sour, aloe, pepper, long pepper, sal-
amoniac and dates).119 Most of these are known to be used for such treatments; however,
some substances such as zinc which were normally used to treat eye diseases are missing
from these recipes.
The instructions are detailed and seem professional, although most of the recipes do not
have specific weights and measures, unlike those in books and practical prescriptions. At
least one of the recipes, the third in fact, presents traditional medicine on account of the
substances recorded, mainly goat (beard) and goat (blood), which would suggest that this
notebook is an example of traditional medicine used by the people portrayed in Genizah
manuscript. The author inserts a personal comment into almost every recipe, for example,
superlatives such as ‘marvelous’ and ‘see great benefit’. The expression ‘may God help
us’, is formulaic closing typical of medical as well as other kinds of prescriptive texts.
In general, the people portrayed in Genizah manuscripts suffered from eye diseases just
like their ancestors,120 for the most part because of the hot climate.121 Since early times,
eye diseases have been a major medical problem in Egypt. The relatively large number
of medical books found in the Genizah dealing with ophthalmology, and the fact that eye
diseases were the most important issue in medical notebooks, attest to this assertion.
Although there were differences between the various cultures in which some evidence
of treatment for eye diseases has survived, such as in Assyria, Babylonia and Egypt,
many of their ophthalmologic practices were more similar than dissimilar.122 Important
information regarding eye diseases and their treatment comes from ancient Egyptian
sources; a chapter of the Ebers Papyrus (sixteenth century BC) is devoted to eye
disorders.123 The lotions described in the papyrus contained cream and milk; however,
the salves (collyrium) contained materials such as antimony, cooper vitriol, goose grease,
119 See entries in Lev and Amar, op. cit. (note 41).
120 Arlington Colton Krause, ‘Assyro-Babylonian Ophthalmology’, Annals of Medical History, (New Series) 6
(1934), 42–55; Julius Hirschberg, The History of Ophthalmology, Frederic C. Blodi (trans.), 11 vols, (Bonn:
Wayenborgh, 1982 and 1985); Harald Nielsen, Ancient Ophthalmological Agents: A Pharmaco-Historical Study
of the Collyria and Seals for Collyria Used During Roman Antiquity, As Well As of the Most Frequent Components
of the Collyria (Odense: Odense University Press, 1974).
121 John Sandford-Smith, Eye Diseases in Hot Climates (London/Boston: Wright, 1990), Michael Walters Dols
and Sulayman Jamal Adil, Medieval Islamic Medicine: Ibn Rid
.w¯
an’s Treatise ‘On the Prevention of Bodily Ills
in Egypt’ (Berkeley/Los Angeles/London: University of California Press, 1984).
122 Daniel M. Albert and Diane D. Edwards, The History of Ophthalmology (Oxford/Cambridge, MA: Blackwell
Science, 1996), 1.
123 Cyril P. Bryan, The Papyrus Ebers (London: G. Bles, 1930), 94.

508 Efraim Lev
honey, lapis lazuli, myrrh, onion, ox marrow and saltpeter.124 According to Albert and
Edwards not only were eye problems common, but their treatment was given some
priority.125 Estes found that 11.2% of all recipes mentioned in the Ebers Papyrus were
for eye disorders.126 The most commonly recommended substances for eye diseases are,
asafetida, balm of Mecca, blood, dung, frankincense, galena, malachite, marrow, myrrh,
ochre (red) and ochre (yellow).127
The people in the Eastern medieval world continued to suffer from eye diseases and the
doctors had to treat them accordingly. For example, Dols argued that: ‘Medieval doctors
were general practitioners but might also have a special skill in ophthalmology, bone-
setting, pharmacology, or surgery’.128 According to Savage-Smith: ‘Ophthalmology was
the only area, besides pharmacology, that could be called a specialty’.129 And indeed,
Arab physicians displayed particular concern and skill in the diagnosis and treatment of
eye diseases;130 most of the Arabic medical compendium has chapters concerned with eye
diseases, and many monographs were devoted to eye disorders.
Two early writers who should be mentioned are H
.unayn Ibn Ish
.¯
aq (ninth century) and
his teacher Ibn M¯
asawayh, both being among the first Arab physicians who wrote on this
subject. The influential monograph on ophthalmology Ten Treatises on the Eye written
by H
.unayn was based to a large extent on Greek sources,131 yet it showed considerable
advancement in knowledge over the Byzantine treatises. H
.unayn mentions in his book
that he wrote it as a result of requests made by many physicians.132 The Iraqi physician
al-Kind¯
ı in his ’Aqr¯
ab¯
adh¯
ın [Medical Formulary], designated 30 drugs for the treatment of
eye diseases which was one of the major ailments from which medieval people suffered.133
Many other recipes are found in books written by physicians such as S¯
ab¯
ur Ibn Sahl,134
K¯
uhin ’At
.t
.¯
ar al-Isr¯
a’¯
ıl¯
ı135 and Ibn Ab¯
ı al-Bay¯
an.136 One of the most highly regarded of all
of the ophthalmological manuals covering 130 eye ailments was written by ’Al¯
ı Ibn ’Isa
who practiced in Baghdad.137 Thanks to the Genizah, we now definitely know that it was
widely used by the Jewish physicians in medieval Egypt.
As mentioned above, several dozen fragments of books on ophthalmology have been
found in the T–S Genizah collection, many of which have been identified as belonging to
’Al¯
ı Ibn ’Isa’s Tadhkirat al-Kah
.h
.¯
al¯
ın.138 A dozen of practical prescriptions also deal with
eye diseases.
124 Georg Ebers, Papyrus Ebers (Leipzig: W. Engelmann, 1875).
125 Albert and Edwards, op. cit. (note 122), 7.
126 Worth J. Estes, The Medical Skills of Ancient Egypt, 2nd edn (Canton, MA: Science History Publications,
USA, 1993).
127 Ibid.; Albert and Edwards, op. cit. (note 122), 8.
128 Dols and Adil, op. cit. (note 121), 36.
129 Savage-Smith, op. cit. (note 2), 948–50.
130 Ibid.
131 H
.unayn Ibn Ish
.¯
aq, The Book of the Ten Treatises on the Eye, Max Meyerhof (ed. and trans.) (Cairo:
Government press, 1928).
132 Savage-Smith, op. cit. (note 2), 948–50.
133 Levey, op. cit. (note 106), 11, 13, 162–86, 190–1, 196, 204–6.
134 Kahl, op. cit. (note 96) 4, 16. 154, 278, 358, 359, 361, 364, 367, 369, 370, 372, 373, 378.
135 al-’At
.t
.¯
ar, op. cit. (note 43).
136 D¯
aw¯
ud Ibn Ab¯
ı al-Bay¯
an, ’al-Dust¯
ur; EI, III, 683; Lev, Chipman and Niessen, op. cit. (note 29).
137 Casey A. Wood, Benevenutus Grassus of Jerusalem, De Oculis (California: Stanford University Press, 1929).
138 ’Al¯
ı Ibn ’¯
Is¯
a al-Kah
.h
.¯
al, Tadhkirat al-kah
.h
.¯
al¯
ın, in Fuat Sezgin (ed.) (Frankfurt am Main: for the History of
Arabic-Islamic Science at the Johann Wolfgang Goethe University, 1997).

Mediators between Theoretical and Practical Medieval Knowledge 509
T–S Ar.45.40 (figure 5)–Notebook: Pharmacopoeia. Judaeo-Arabic; Oriental semi-
cursive script; vellum; 2 leaves (1 bifolio, mutilated and stained; 13 ×27.8 cm; 10–15
lines; f.2r is blank. Recipes for a dressing applied to the liver region and the preparation
of berberis tablets (pastilles) [tenth–eleventh century].139
T–S Ar.45.40 – (recto) right. Text (Transcription):
T–S Ar.45.40 – (recto) right. Translation:
1. Recipe for berberry pastilles
2. Take berberry and clean nard
3. Stick of liquorice clean of the black ones,
4. of each a weight of 2 dirhams,
5. and peeled seeds of chate melon140
6. 2 dirhams, and bamboo chalk
7. and seeds of purslane, of each one
8. dirham and 1/3, and rose
9. crushed 4 dirhams, and saffron
10. and starch and clean lac
T–S Ar.45.40 – (recto) left. Text (Transcription):
139 Isaacs, op. cit. (note 13), no. 671; Jefferson and Hunter, op. cit. (note 118), 158.
140 Cucumis melo var. chate; see Zohar Amar and Efraim Lev, ‘Watermelon, Chate Melon, and Cucumber: New
light on Traditional and Innovative Field Crops in the Middle Ages’, Journal Asiatique, 299 (2011), 193–204.

510 Efraim Lev
(a)
(b)
Figure 5: Judaeo-Arabic pharmacopoeic notebook (T–S Ar.45.40).
T–S Ar.45.40 – (recto) left. Translation:
1. Over fire and crush one dirham camphor and add water to it (dilute)141
2. Cool it and place in [two cauldrons] beneficial if God wills
3. Recipe for dressing placed on the liver: take a weight of 4 dirhams
4. Roman absinthian wormwood and sandalwood and rose and barley flour and broad
bean flour,
5. of each one a weight of 2 dirhams, and betel palm of weight 1 dirham,
6. saffron of weight 7 dirham, camphor of weight 0.25 dirham. Crush
7. all of it and knead it with coriander water and chicory water
8. and dress the liver; beneficial if God wills
141 A few drops probably by vaporization and condensation.

Mediators between Theoretical and Practical Medieval Knowledge 511
9. Recipe for cough beneficial. Take from seeds of myrtle
10. 2 dirhams, and tragacanth ..... of weight a dirham,
11. rose made as jam and .....
12. tragacanth and knead it with rose [water]
13. in the morning and in the evening and in.....
Commentary
This fragment is clearly eclectic, and also represents a good example of the form of
medical notebooks:
•It consists of at least two bi-folios;
•The recipes have different shapes;
•The handwriting varies;
•The size of the letters of the different recipes is not the same.
One of the recipes is exclusively for the treatment of the liver (according to its title) and
the second is for liver ailments (according to contemporary books). On the verso there is
a recipe for cleaning lac, which is a major ingredient in one of the recipes.
The medicinal substances listed in these recipes are the following:
(recto)right: berberry, nard, liquorice, chate melon, bamboo chalk, purslane, rose,
saffron, starch and lac.142 This recipe (berberry pastilles) is similar (same ingredients in a
different order) to recipe no. 204 in S¯
ab¯
ur Ibn Sahl, al-Aqr¯
ab¯
adh¯
ın al-S
.agh¯
ır (The Small
Dispensatory). According to S¯
ab¯
ur Ibn Sahl it was used for fever, thirst and tumours of
the liver and stomach.143 These ingredients weighed about twenty-four grams.
(recto)left: 1. Camphor. These two lines are the last part of a recipe the beginning
of which is missing (it is probably on the missing bifolio that was the inner part of the
notebook). 2. Roman absinthian, wormwood, sandalwood, rose, barley, broad bean, betel
palm, saffron, camphor, coriander and chicory.144 This recipe for the treatment of the
liver has a weight of about twenty-two dirhams (about seventy-seven grams) plus the
water. 3. Tragacanth, myrtle, rose (jam and water).145 This is an incomplete recipe for
the treatment of coughs. In general it might be either lohoch (electuary; Arabic: la’¯
uq) or
syrup (Arabic: shar¯
ab). Recipes for cough relief in the Arabic medical literature include
various combinations (for the synergetic effect) of the mucilages and syrups produced
by cooking the fruits or seeds of the relevant plants, or are produced from the gummy
sap of particular trees. In our case the rose (jam and water) and gum tragacanth are the
ingredients whose main effect on the respiratory system is to soothe irritated membranes;
such substances were usually combined with the ‘active ingredients (that are missing in
our case).146
T–S Ar.42.67 (recto)(figure 6)–Prescriptions of lesser and greater triphala, Arabic;
Ruq’ah script; paper; 1 leaf; stained; 10.6×14.8 cm; 8 lines; verso is blank. Two formulae
[eleventh–twelfth century].147
142 See entries in Lev and Amar, op. cit. (note 41).
143 S¯
ab¯
ur Ibn Sahl, op. cit. (note 96), 132–3; Kahl, op. cit. (note 96), 113.
144 See entries in Lev and Amar, op. cit. (note 41).
145 Ibid.
146 Leigh Chipman, ‘How Effective were Cough Remedies Known to Medieval Egyptians?’, Korot, 16 (2002),
142–3.
147 Isaacs, op. cit. (note 13), no. 436.

512 Efraim Lev
Figure 6: An Arabic notebook consisting of unique prescriptions (T–S Ar.42.67).
T–S Ar.42.67 (recto). Text (Transcription):
T–S Ar.42.67 (recto). Translation:
1. Recipe of the lesser triphala
2. Take of cleaned chebulic and yellow myrobalan, Indian [myrobalan] and emblic
[myrobalan], half a dirham each;
3. Pound and mix in one ¯
uqiyya of odourless sweet almond oil and add to it one rat
.l
4. of bees’ honey skimmed of froth. Take and use.
5. And the greater triphala, should be added
6. dried turpeth, one mithq¯
al; sifted white agaric, one mithq¯
al; meadow saffron, two
dirhams;
7. orchid, one dirham; indigo seed, one dirham; lavender, one mithq¯
al; aloeswood
8. one dirham; ginger one dirham. The dose is one mithq¯
al in hot water

Mediators between Theoretical and Practical Medieval Knowledge 513
Commentary
The medicinal substances mentioned in these recipes are as follows:
•Lesser triphala – myrobalan (chebulic, cleaned), myrobalan (yellow), myrobalan
(Indian), myrobalan (emblic), almond (sweet, oil), honey (bees’ – skimmed of froth);
•Greater triphala – turpeth (burnt/dried), white agaric (sifted), meadow saffron, orchid,
indigo (seed), lavender, aloeswood, ginger.148
Their main medical characteristic is the treatment of stomach ailments, especially as
a purgative. The pharmacological aspect of concocting the recipe is to grind all of the
ingredients, then pound and mix them in one ¯
uqiyya (33.85–37.5 grams)149 of odourless
sweet almond oil and add to it one rat
.l of bees’ honey skimmed of froth.
The total weight of the recipe described in this prescription is: 1. Lesser triphala – 490
grams; 2. Greater triphala – add thirty-three grams; altogether 522 grams. Since the author
wrote that ‘The dose is one mithq¯
al in hot water’ the amount here is good for 111 doses.
This leads to the assumption that this recipe was more for the use of pharmacists.
Triphala (at
.r¯
ıfal,it
.rifil,it
.rift,itriful, ’it
.r¯
ıful in Arabic), is a compound laxative. Here
it is probably the Tibetan/Indian drug tripala. According to Sbath and Avierinos, it is
‘confections made of the three kinds of myrobalans, chebulic, embolic, and belleric’.150
Levey believes that it is the ‘Arabised’ form of the Indian name. It applies to three kinds of
myrobalans: kabul, belleric and embolic, that ‘strengthens the nervous organs and aids the
organs of nutrition in regard to waste excesses’. Usually they are made up of equal weights
due to their similar usefulness and strength.151 A prescription for yellow ’it
.r¯
ıful was found
in the Genizah (T–S Ar.41.81). It was used for the treatment of piles (haemorrhoids)
and contained honey, myrobalan (black, yellow and chebulic myrobalan), bdellium, sugar
candy, caper-root, leek seed, camel dung, long aristolochia and harmala seed.
Maimonides mentions the great ’it
.r¯
ıful in his books which was used for strengthening
various organs, especially the heart and the senses, for delaying aging, and helping in
coitus.152 It contains: parsnip, balsam bark, ginger, musk, rose seed, galangal, almonds,
almond oil, aloe wood, anise, borage, cardamom, carrot seed, long pepper and myrobalan
[Indian, beleric, embelic, yellow].153
Conclusion
As mentioned before, the identification of Genizah fragments that belong to the genre
of medical notebooks occurred during the course of our study of the above-mentioned
UK Genizah collections. These documents provide the most direct evidence we have
148 See entries in Lev and Amar, op. cit. (note 41).
149 Goitein, op. cit. (note 11), II, 267; Hinz, Walther, Islamische Masse und Gewichte (Leiden: Brill, 1970).
150 Paul Sbath and Christo D. Avierinos, Deux traits medicaux (Le Caire: Impr. de l’Institut franc¸ais
d’arch´
eologie orientale, 1953).
151 Martin Levy, The Medical Formulary of Al-Samarkand¯
ı(Philadelphia: University of Pennsylvania Press,
1967), 69–70.
152 Moshe Ben Maimon (Maimonides), Regimen Sanitatis, in Sussmann Muntner (ed.), (Jerusalem: Mosad
Harav Kook, 1957), (Hebrew). 3:11.
153 Ibid., 3:1; Moshe Ben Maimon (Maimonides), The Medical Aphorisms of Moses Maimonides, in Fred
Rosner and Sussmann Muntner (eds) (New York: Yeshiva University Press, 1970), 21:72; Moshe Ben Maimon,
(Maimonides), Sexual Life (On the Increase of Physical Vigour), in Muntner Sussmann (ed.) (Jerusalem: Geniza,
1965). (Hebrew). Introduction, Section 2.

514 Efraim Lev
for preferred practical medical recipes because they record the choices of medical
practitioners in medieval Cairo.
There is no clear-cut answer to the first research question: Who wrote the notebooks
and for what purpose? However, a few options were suggested:
•Cairene Jewish practitioners;
•Medical students (both keeping preferred recipes);
•Traditional healers (recipes kept for professional needs and uses);
•Ordinary people (recipes kept for personal or family use).154
It seems as though there is no single right answer; moreover, each notebook is a different
case and therefore generalisation is not an option in this matter. The language of preference
for the authors of the medical notebooks in the Genizah was undoubtedly Judaeo-Arabic;
therefore, they were evidently Jewish. The bulk of the information contained in the
notebooks is medical recipes; there are also methods of healing and few notebooks on
medical theories.
The subject matter of the Genizah medical notebooks shows that they were mostly an
eclectic combination of recipes which their owners had probably heard about from their
teachers [A, see diagram in figure 3], learned at the hospitals where they worked [B],
prescribed to their patients [C] or copied from books they read [D]. Although the medical
notebooks found in the Genizah are not as complete as the medical commonplace books
from fifteenth century England that were studied by Jones, we can learn from his research
studies about their characteristics which in certain cases were similar. For example, with
regards to the sources of the writer’s medical knowledge, he found that it was derived
‘from personal experience to what he had seen or heard from other practitioners, to what
he had read in the works of others’.155
As for the third question about the kind of medical knowledge recorded in the notebooks
and their topics, it was found that the foremost medical genre mentioned in the notebooks
was pharmacopoeic, namely the collection of recipes for the treatment of various diseases.
There are also a few notebooks on materia medica [E]. Regarding specialised notebooks,
eye diseases are first, followed by skin diseases, coughs and colds, dentistry and oral
hygiene and gynaecological conditions. As for where the recipes originated, since we have
not succeeded in identifying the source of the great majority of recipes either in printed
books or in manuscripts, they appear to be original. As mentioned above a similar point
was made by Andorlini about the contents of Egyptian medical papyri of the classical
period.156
From the bibliographical survey we learn that the genre of notebooks and other such
compendiums is not new. Notebooks had been in use in a number of ways since classical
times, but we do have some historical allusions as to their uses for medical purposes. As
part of the oral and written transmission of knowledge, teachers in Early Islam based their
lectures and seminars on “‘collections” of data and “lecture scripts”’ that were arranged in
154 Based on an in-depth study of the Genizah’s culture, medieval medical atmosphere, Jewish and Muslim
writings, and ethno-medicine and ethno-pharmacology in contemporary Middle Eastern societies and ethnic
groups.
155 Jones, op. cit. (note 23), 36–7.
156 Andorlini, op. cit. (note 8), 23–33.

Mediators between Theoretical and Practical Medieval Knowledge 515
notebooks.157 Notebooks were also a humanistic method of storing information including
realia, medical synonyms and recipes, for easy access.158
The writers of the medical notebooks in the Genizah concentrated mainly on the
practical medical knowledge they wanted to record, probably for their future use as
amateur physicians, students, traditional healers or professional practitioners [F]. Hence,
most of the notebooks are pharmacopoeias containing recipes for various ailments, a
specific disease or organ, and materia medica; only a few notebooks are about medical
theory. Theoretical knowledge was extensive and important for the training of practitioners
and accessible in their own libraries or even homes, but it was less central to the daily
routine of treating patients. Notebooks, in general, were apparently meant to serve as
memoranda, be it for a scholar or a practitioner. In the case of physicians or pharmacists,
notebooks had a practical aim – to allow the practitioner ready access to the required
medical information without resorting to the original books [F]. I argued here that the
notebooks were also a form in which some of the earliest and well-known pharmacopoeias
were composed. The authors acquired and accumulated practical knowledge and recipes
and only later compiled and published this material as books [G]. It was most probably
actual practice that drove the practitioner to compile the medical notebook.
I strongly suggest that this genre should be kept in mind when newly discovered
manuscripts on medicine and other subject matters are studied.
157 Gunther, op. cit. (note 59), 78.
158 Blair, op. cit. (note 68); Schiffman, op. cit. (note 69); Bos and Mensching, op. cit. (note 72); Thomas, op. cit.
(note 67); Robinson, op. cit. (note 70); Boffey, op. cit. (note 65); Jones, op. cit. (note 90); Green, op. cit. (note
101).